Cape Town - At least 50% of women requesting tubal ligation (sterilisation) as a form of contraception actually end up receiving the procedure.
This is according to research published in the South African Medical Journal, titled “Access to post-partum tubal ligation services in Cape Town, South Africa – an observational study”.
Researchers from UCT wanted to assess the access to tubal ligation services in women who request permanent contraception following delivery.
Tubal ligation is a form of sterilisation, also known as having a woman’s “tubes tied”, where the fallopian tubes are cut, tied or blocked to prevent future pregnancies.
The study was conducted as a cross-sectional observational study collecting data three months, from June 2019 to August 2019 at four local hospitals.
The study population included women aged between 25 and 46 years, with a mean age of 34.
Almost half the population (49.6%, 129/260) were women of advanced maternal age (≥35 years), who had between zero and nine children.
“Of the 260 women included in the study, 129 women received a tubal ligation at the time of discharge.
“Two women received interval sterilisations.
“Alternative methods of contraception were used in 115 (87%) of the remaining 131 women.
“Injectables were the most common form of alternative contraception (83/115), followed by Implanon (18/115) and intrauterine contraceptive device (10/115).
“Sixteen women were discharged without contraception.”
Researchers explained the reasons could be due to limited theatre time, as 58% of deliveries at these facilities are via caesarean section.
“Post-partum tubal ligations are often delayed by hours or even days because of theatres constantly being used for elective and emergency caesarean sections.
“New Somerset Hospital (NSH) (for example) has a single obstetric operating theatre for elective and emergency caesarean sections.
“This is the same theatre where post-partum tubal ligations take place.
Patients who deliver vaginally are typically discharged from the hospital or MOU within six to 24 hours after delivery. The delay in access to theatre often leads to the patients changing their minds regarding tubal ligation.”
Suggestions to improve access include organising sterilisation drives where doctors working in obstetrics and gynaecology run a dedicated tubal ligation theatre list on a monthly basis.
“We plan on presenting the findings to local stakeholders to highlight the lack of access and subsequent unplanned pregnancies in a bid to find solutions,” researchers added.
Western Cape Health department spokesperson Mark Van der Heever said: "Bilateral tubal ligation is a permanent form of contraception. There are guidelines for recommending other forms of contraception if a woman is younger than 30, has less than two children and/or is not in a stable relationship. These are guidelines to reduce the risk of post-sterilistation regret.
“The decision to perform a tubal ligation is individualised and done in consultation with the woman and includes extensive counselling and informed consent.”
Cape Times